Sports Medicine: Just the Facts

1. The long-term effects of a sedentary lifestyle are
   numerous including functional limitations from
   chronic disease, obesity, diabetes mellitus, and car-
   diovascular disease.


2. It has been estimated that 35% of deaths from
   coronary heart disease, 32% from colon cancer,
   and 35% from diabetes could be prevented if all
   Americans exercise.

• Successful aging appears to include a combination of
  physical, cognitive, and social activities with the most
  rewards coming from continued physical and mental
  activity (Pescatello, 2001; Cassel, 2002).
  •Even though the prospect of starting an exercise or
  physical activity program may seem hard or possibly
  dangerous for many older adults, as a group, they are
  fairly resilient with respect to cardiovascular endurance
  and strength even after a period of detraining (Albert
  et al, 2000; Begum and Katzel, 2000; Sforzo et al,
  1995).

BENEFITS OF EXERCISE

• Many factors are associated with older adults partici-
  pating in regular aerobic exercise as well as being
  physically inactive (Table 97-1) (Edward, Larson,
  and Wagner, 1992; Seeman et al, 1995; King et al,
  2000).
  •Exercise as a form of primary prevention has many
  benefits even for sedentary older adults (Table 97-2).
  (DiPietro, 2001; Vita et al, 1998; Miller et al, 2000;
  Penninx et al, 2001; Speechley and Tinetti, 1991;
  Gardner, Robertson, and Campbell, 2000; Nowalk
  et al, 2001; Shephard and Balady, 1999; Hakim et al,
  1999; Kasch et al, 1999; Kasch et al, 1999;
  Hambrecht et al, 1998; Maiorana et al, 2000; Billman,
  2002; Pratley et al, 2000; Pescatello and Murphy,
  1998; Frontera et al, 1988; Evans, 1995a; 1996;
  McAuley et al, 2000; Gregg et al, 1998; McMurdo,
  Mole, and Paterson, 1997; Messier et al, 2000;

Pescatello, Murphy, and Costanzo, 2000; Pescatello

and VanHeest, 2000; Andersen et al, 1999; Miszko

and Cress, 2000)

PHYSIOLOGIC CHANGES OF AGING

• Aging is associated with many physiologic changes
  (Table 97-3).


• The age-associated decrease in muscle mass (sarcope-
  nia) is a direct correlate of the age decrement in
  strength, which in turn leads to functional impair-
  ments and disability (Evans, 2003). Many of the phys-
  iologic changes once thought to be part of the aging
  process are now considered to be more a consequence
  of disuse and a sedentary lifestyle.


• Aerobic exercise as measured by maximal aerobic
  capacity (VO2max) declines approximately 1% per
  decade after the age of 20–25. This decline is seen in
  both sedentary and competitive older athletes
  (Mengelkock et al, 1997; Wiswell et al, 2001). It is the
  best single marker of an individuals cardiovascular fit-
  ness.


• In most physiologic systems, the aging process does
  not result in significant impairment or dysfunction in
  the absence of pathology; however, stress on physio-
  logic reserves can lead to an inability to complete a
  task requiring near maximal effort (Fiatarone-Singh,
  2002).

566 SECTION 7 • SPECIAL POPULATIONS

TABLE 97-1 Participant and Non-participant Factors
Associated with Regular Exercise

POSITIVE FACTORS NEGATIVE FACTORS

Age Fear of undue harm from
physical activity
Positive health perception Care-giving responsibilities
Higher levels of education Lack of energy to exercise
and income
Less than two chronic Absence of enjoyable scenery
health conditions
Prior exercise behavior Infrequent observations of others
Supportive social network.74–75 exercising in ones neighborhood.^76

TABLE 97-2 Benefits of Exercise for Older Adults

Improve and/or maintain muscle strength

Improve and/or maintain endurance and mobility

Retain musculoskeletal integrity

Decreased falls with reduction in overall rate of hip fractures

Prevention of coronary artery disease, hypertension, diabetes mellitus,

obesity and osteoporosis

Improved lipid levels including increased HDLc

Improved physical appearance and self-confidence

Improved well-being (less worry, anxiety, and depression)

Enhances regularity of bowels–less constipation

TABLE 97-3 Physiologic Changes Associated with Aging

Decreased skeletal muscle mass (sarcopenia)

Decreased basal metabolic rate and energy expenditure (decreased

caloric need)

Graying and thinning hair

Decrease in skin and ligamentous and tendon elasticity

Reduction in height (loss of intravertebral disc space height)

Changes in the speed of cognitive processing and retention of new

information

Slowing of reaction time

Presbyopia and presbycusis.